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Sep 29 05 02:12p Hods & Girls Club Of Sant 714 -565 -1099 p.3 <br />FROM :CITY OF SANTA ANA CDR FAX NO. :714 647 -6736 Sep. 27 2005 05:29AM P3 <br />Certification Regarding Lobbying <br />Certification for Gmtracts. Grants. Loons. and Cotticrative Agreements <br />The undersigned cettifics, to the hest of his or her knowledge and belief, that, <br />(t) No Federal appropriated funds have been paid or will be paid, by or on behalf of the <br />undersigned, to any person for influencing or attempting to influence an Officer or <br />employee of uny agency, a Member of Congress, an officer or employee of Congress, or <br />an employee of a Member of Congress in connection with the awarding of any Federal <br />contract, the making of any cooperative agreement, and the extension, continuation, <br />renewal, amendment, or modification of any Federal contact, grant, loan or cooperative <br />agreement. <br />(2) if any funds other than Federal appropriated funds have been paid or will he paid to <br />any person for influencing or attempting to influence an officer or employee of any <br />agency, a Member of Congrex+, an officer or employee of Congress, or an employe of a <br />Member of Congress in connection with this Federal contract, grant, loan, or cooperative <br />agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure <br />Form to Report Lobbying," in accordance with its instructions. <br />(3) The undersigned shall require that the language of this certification be included in the <br />award documents for all subawards at all tiers (including subcontract, subgrants, and <br />contracts under grunts, loans, and cooperative agreements) and that, all subrecipientx shall <br />certify and disclose accordingly. <br />This certification is a material representation of fact upon which relianco wax placed <br />when this transaction was made or entered into. Submission of this certification is a <br />prerequisite for making or entering into this transachon imposed by Section 1352, Title <br />31, U. S. Code. Any person who fails to file the required certification shall he suhject to <br />a civil penalty of riot less than $10,000 and not more than S 100,000 for each such failure. <br />nano: or �eartty1u:9 Utrrcer Signature Date <br />exH19IT C <br />Page I oft <br />